Departmental Process Research Articles

Program evaluation and healthcare process improvement focused on complex wheelchair procurement

ABSTRACT The operations of a specialty wheelchair (WC) seating center can influence the evaluation to delivery timeframe in days for a complex rehab technology (CRT) WC. Operations at one facility improved due to departmental process improvement (PI) project with evaluation of the delivery workflow and implementation of changes. A retrospective chart audit gathered baseline data on the evaluation to delivery timeframe in days of a CRT WC for 50 individuals prior to PI changes. Standard departmental workflow collected 745 individuals’ post-PI changes. The interventions took place from March 25, 2017, to April 5, 2018, and included defining and educating stakeholders on their roles and expectations, revisions of the electronic medical record, weekly and quarterly meetings with supplier leadership, paperwork completion goals, and follow-up paperwork centralization. Mean pre- and post-intervention evaluation to delivery timeframes in days was significantly different (162.2 versus 127.4 days, p < 0.0001). Overall, a reduction in the mean evaluation to delivery timeframe in days of CRT WC by 21.5% or 34.8 days occurred. Systematic change takes time as well as the commitment of all key players. PI changes resulted in evaluation to delivery timeframe reduction for patients to receive their CRT WCs.

Implementation of Data-Driven Timelines and Visual Guidance Tools to Improve Radiation Oncology Task Completion: “Plan Readiness”

<h3>Purpose/Objective(s)</h3> The time between physician treatment plan approval and patient treatment initiation is often too short in our current Radiation Oncology practice. This reflects inconsistencies in the timeframe of task completion between CT simulation and treatment plan approval, the first and last steps in a complex, multi-step planning workflow in Radiation Oncology. This poses challenges in terms of the QA and plan checks needed prior to treatment initiation, with potential implications for patient safety. Our goal was to implement a sustainable and clear departmental process that would increase the percentage of plans approved by the attending Radiation Oncologist 1 full business day prior to treatment start for all non-urgent patients. Secondary goals included a reduction in last-minute patient delays and improvement in team member engagement and satisfaction. <h3>Materials/Methods</h3> We established realistic timelines for each task from simulation to treatment initiation, while setting a cutoff time for implementing patient appointment delay when expectations were not met. Treatment site, technique, and complexity-specific timelines were built by our team based on 4 major factors: 1) Clinical Urgency, 2) Task Complexity, 3) Evaluation of "task completion" data from a large cohort of previously treated patients, and 4) Interviews with all team members involved in the treatment planning process. These timelines were generated in a visual task management tool, and were linked as serial or parallel to keep the entire team on schedule for each patient. Prior to implementation, appropriate departmental meetings were held to discuss these changes, with extensive team member feedback utilized to generate the new policy. Timelines were generated that ranged from 5 to 12 working days, with clear goals and guidelines for each involved team member regarding their task(s). Our overarching goal, termed "Plan Readiness", was to achieve an electronically approved treatment plan 1 full working day prior to treatment start for > 90% of our patients. Appropriate exclusions were made for emergencies and special/new procedures in the department. <h3>Results</h3> For the 5 months prior to implementation, our baseline data demonstrated that 71% of plans were electronically approved in our treatment planning system greater than 24 hours prior to treatment start. After implementation of our new "Plan Readiness" process in March 2021, we have been able to stay above 90% pass rate, with a cumulative average of 94.6% over an ongoing 10-month timeframe. <h3>Conclusion</h3> The design and execution of data-driven timelines and visual guidance tools, combined with a team-based approach of communication and open feedback, has resulted in preliminary favorable outcomes in achieving timely "Plan Readiness" in our relatively large, hospital-based Department of Radiation Oncology. Future directions include the use of analytics software and automated data collection to perform more robust assessments.

Analysis the Recruitment and Selection Process of Elementary School Teachers in Azad and Jamu Kashmir

The present study attempted to evaluate the recruitment and selection process of elementary school teachers in AJ&amp;K. The study involved analysis of collected quantitative data through survey instruments for elementary school teachers and their selectors. Study was delimited to elementary school teachers of high, elementary public schools and their selectors of district Poonch. Major objectives of the study were to find out the internal and external factors which affect (influence) the selection process of teachers and to evaluate the current teacher selection process. Sample of the study was comprised on 16 selectors, 200 head teachers and 400 elementary school teachers male and female of public schools of district Poonch. Data were collected by personal visits and postages. Three parameters were determined for this study. These were internal factors that were affecting recruitment process, evaluation of existing selection process, finding recruitment criteria and factors influencing to it. All three parameters of the study such as internal and external influencing factors and evaluation of current selection process were not accepted at 0.05 significance level with df-4.It was concluded that current selection process was greatly influenced by above mentioned indicators in the past selection process as well as in current selection process. It was concluded that current selection process was better than previous departmental process although at the time of interview it was influenced by different authorities. It was recommended that selection should be clear, unbiased and according to future educational needs.

LEGAL NATURE OF DEPARTMENTAL REGULATIONS

The article is devoted to the establishment of the legal nature of departmental regulations. The main parameters and scope of rule-making competence of federal executive bodies are examined. Because of the heterogeneity of departmental normative acts, there is a need to develop a general multistage classification of departmental regulations, the creation of which will also help determine their legal nature. Based on the analysis, a conclusion was made on the need for legislative regulation of the rule-making competence of federal executive bodies, as well as the procedure for implementing a departmental norm-setting process in the Russian Federation. The question is debated whether the departmental normative acts are sources of law. It is concluded that departmental regulations perform the same functions as all other normative legal acts, that is, they create norms of law, modify and supplement existing norms, and in some cases cancel them. Consequently, these acts are sources (forms) of law. The problem of the place, which departmental normative acts occupy in the system of subordinate normative acts, is being discussed. In conclusion, the author comes to the inference that departmental regulations possess all the features of by-laws. It is noted that departmental regulations act as acts of developing norm-setting, since they carry out the functions of detailing and concretizing laws, acts of the President and the Government.

Patterns of Incident Reporting Across Clinical Sites in a Regionally Expanding Academic Radiation Oncology Department

PurposeWe evaluated patterns of event reporting across five clinical locations within an academic radiation oncology department, with the goal of better understanding variability across sites. Methods and MaterialsWe analyzed 1,351 events reported to a departmental incident learning system over 1 calendar year across the five locations with respect to volume of events, event type, process map location of origin and detection, and event reporter. ResultsWe found marked variability in reporting patterns, including reporting rate, event type, event severity, event location of origin and detection within the departmental process map, and discipline of event reporters. These differences relate both to variability in process and workflow (reflected by frequency of specific workflow events at each site) and in reporting culture (reflected by volume or rate of event reporting, and discipline of event reporter). ConclusionsThese data highlight the variability in reporting culture even within a single department, and therefore the need to tailor and individualize safety and quality programs to the unique clinical site, with the long-term goal of achieving a common culture of safety while supporting unique processes at individual locations. This work also raises concern about extrapolating single-institution incident learning system results without understanding the unique workflow and culture of clinical sites.

Departmental Workload and Physician Errors in Radiation Oncology.

The purpose of this work was to evaluate measures of increased departmental workload in relation to the occurrence of physician-related errors and incidents reaching the patient in radiation oncology. All data were collected for the year 2013. Errors were defined as forms received by our departmental process improvement team; of these forms, only those relating to physicians were included in the study. Incidents were defined as serious errors reaching the patient requiring appropriate action; these were reported through a separate system. Workload measures included patient volumes and physician schedules and were obtained through departmental records for daily and monthly data. Errors and incidents were analyzed for relation with measures of workload using logistic regression modeling. Ten incidents occurred in the year. The number of patients treated per day was a significant factor relating to incidents (P < 0.003). However, the fraction of department physicians off-duty and the ratio of patients to physicians were not found to be significant factors relating to incidents. Ninety-one physician-related errors were identified, and the ratio of patients to physicians (rolling average) was a significant factor relating to errors (P < 0.03). The number of patients and the fraction of physicians off-duty were not significant factors relating to errors.A rapid increase in patient treatment visits may be another factor leading to errors and incidents. All incidents and 58% of errors occurred in months where there was an increase in the average number of fields treated per day from the previous month; 6 of the 10 incidents occurred in August, which had the highest average increase at 26%. Increases in departmental workload, especially rapid changes, may lead to higher occurrence of errors and incidents in radiation oncology. When the department is busy, physician errors may be perpetuated owing to an overwhelmed departmental checks system, leading to incidents reaching the patient. Insights into workload and workflow will allow for the development of targeted approaches to preventing errors and incidents.

Staff Nurses' Perceptions and Experiences about Structural Empowerment: A Qualitative Phenomenological Study.

The aim of the study reported in this article was to investigate staff nurses’ perceptions and experiences about structural empowerment and perceptions regarding the extent to which structural empowerment supports safe quality patient care. To address the complex needs of patients, staff nurse involvement in clinical and organizational decision-making processes within interdisciplinary care settings is crucial. A qualitative study was conducted using individual semi-structured interviews of 11 staff nurses assigned to medical or surgical units in a 600-bed university hospital in Belgium. During the study period, the hospital was going through an organizational transformation process to move from a classic hierarchical and departmental organizational structure to one that was flat and interdisciplinary. Staff nurses reported experiencing structural empowerment and they were willing to be involved in decision-making processes primarily about patient care within the context of their practice unit. However, participants were not always fully aware of the challenges and the effect of empowerment on their daily practice, the quality of care and patient safety. Ongoing hospital change initiatives supported staff nurses’ involvement in decision-making processes for certain matters but for some decisions, a classic hierarchical and departmental process still remained. Nurses perceived relatively high work demands and at times viewed empowerment as presenting additional. Staff nurses recognized the opportunities structural empowerment provided within their daily practice. Nurse managers and unit climate were seen as crucial for success while lack of time and perceived work demands were viewed as barriers to empowerment.

Resident Case Review at the Departmental Level: A Win-Win Scenario

Resident Case Review at the Departmental Level: A Win-Win Scenario

Physician and Departmental Performance Metrics in Pediatric Emergency Care: Secondary use of Patient Visit Data

Abstract Objectives To develop, implement, and validate a physician and departmental performance metric feedback process based on secondary use of patient visit data using the level of electronic health record implementation available in most Canadian pediatric emergency departments (PEDs). Methods Patient visit data for the IWK Health Centre PED in Halifax, Canada were used to create individual physician and departmental performance metrics including: physician dwell time, 24 and 72 hour return-rates, admission rates, sign-over rates. Visit acuity was measured using the Canadian Triage and Acuity Scale (CTAS). Feedback directly to physicians was contextual, anonymous, non-proscriptive and non-threatening. Relationships between various performance metrics were analyzed to explore the rational trade-off hypothesis. This data acquisition and analysis has become an annual part of the departmental review process. Results Wide practice variation was found. Exposure to personal performance feedback was associated with positive change in physician behaviour. Analysis failed to find a rational trade-off between increased resource utilization and holistically better care. Physician buy in was excellent. Conclusions At this preliminary stage, surveillance of physician and departmental metrics derived from secondary use of patient visit data shows promise in improving care, dissecting clinical decision making, and (possibly) directing professional development processes. Secondary data analysis, even in small centres and in the absence of sophisticated electronic health records management, can provide clinically and administratively useful data. Further studies, at a multi-centred scale, are planned.

Peer-review of radiation treatment planning in a provincial radiation oncology program: A survey of current practice.

211 Background: The use of peer-review activities in oncology is not well described as a quality improvement process. We sought to describe current patterns of practice of radiation oncology peer-review across a large Provincial Cancer program and to identifiy barriers to its use. Methods: Ontario cancer centres were surveyed. Survey item responses were typically scored using a 10-point Likert scale. The survey was administered electronically with follow-up reminders as required. The use of free-text for comments elaborating on responses was encouraged. Results: Fourteen (100%) centres responded. All rated the importance of peer-review as at least 8/10 (10=extremely important). Detection of medical error and improvement of planning processes were the highest-rated benefits of peer-review (each median 9/10). Four centres (29%) conducted peer-review in more than 80% of cases treated with curative intent; six (43%) peer-reviewed at least 50% of curative cases. Five centres (36%) reported “always” or “almost always” conducting peer-review prior to the initiation of treatment. Variation was seen in which aspects of a case were typically reviewed (e.g., GTV “almost always” reviewed in 67%; contouring of organs at risk in 50%). Five centres (46% of those with regular peer-review) reported that 5% to 9% of peer-reviewed cases were flagged as requiring a change, whereas 3 centres (27%) reported that &lt; 2% of peer-reviewed cases required a change to be made. Five centres (36%) recorded the outcomes of peer-review on the medical record. Thirteen centres (93%) planned to expand peer-review activities; the two factors rated as most limiting to expanding peer-review were a critical mass of radiation oncologists (median score 6/10), and prioritization of peer review by the program overall (median 5/10). Conclusions: Peer review in radiation oncology practices it is now widely used as a quality assurance activity in Ontario, identifies changes to improve quality in the individual case, and improves departmental process. The development of guidelines and standards for peer-review activities, coupled with effective knowledge translation activities are recommended.

Learning analytics as a tool for closing the assessment loop in higher education

This paper examines learning and academic analytics and its relevance to distance education in undergraduate and graduate programs as it impacts students and teaching faculty, and also academic institutions. The focus is to explore the measurement, collection, analysis, and reporting of data as predictors of student success and drivers of departmental process and program curriculum. Learning and academic analytics in higher education is used to predict student success by examining how and what students learn and how success is supported by academic programs and institutions. The paper examines what is being done to support students, whether or not it is effective, and if not why, and what educators can do. The paper also examines how these data can be used to create new metrics and inform a continuous cycle of improvement. It presents examples of working models from a sample of institutions of higher education: The Graduate School of Medicine at the University of Wollongong, the University of Michigan, Purdue University, and the University of Maryland, Baltimore County. Finally, the paper identifies considerations and recommendations for using analytics and offer suggestions for future research.

Learning analytics as a tool for closing the assessment loop in higher education

This paper examines learning and academic analytics and its relevance to distance education in undergraduate and graduate programs as it impacts students and teaching faculty, and also academic institutions. The focus is to explore the measurement, collection, analysis, and reporting of data as predictors of student success and drivers of departmental process and program curriculum. Learning and academic analytics in higher education is used to predict student success by examining how and what students learn and how success is supported by academic programs and institutions. The paper examines what is being done to support students, whether or not it is effective, and if not why, and what educators can do. The paper also examines how these data can be used to create new metrics and inform a continuous cycle of improvement. It presents examples of working models from a sample of institutions of higher education: The Graduate School of Medicine at the University of Wollongong, the University of Michigan, Purdue University, and the University of Maryland, Baltimore County. Finally, the paper identifies considerations and recommendations for using analytics and offer suggestions for future research. https://doi.org/10.34105/j.kmel.2012.04.020

Concept of regional resources and analysis of application of classification system - Focusing on the departmental promotion process by regional industry -

Concept of regional resources and analysis of application of classification system - Focusing on the departmental promotion process by regional industry -

TH-E-M100A-03: Planning the Purchase of a Radiation Therapy Treatment Planning System

Prior to the advent of 3D treatment planning, a radiation therapy treatment planning system (RTPS) operated in near isolation. There were few, if any, interconnections between the planning system and other information systems in the institution. Today, the RTPS operates as one node in a continuum of information systems and processes that can include imaging systems and archives, information systems, other RTPS nodes and systems, and delivery and delivery verification systems. In order to integrate a new RTPS into the departmental process, the planning for purchase of an RTPS must go far beyond the traditional comparisons of contouring, dose calculation algorithms, and dose evaluation tools. This presentation will attempt to guide the medical physicist in planning the purchase of a new RTPS. Issues such as system infrastructure, network architecture, integration planning, and continuing training will be discussed. The medical physicist must consider the changes planned at their institution, such as 4D delivery, adaptive radiation therapy, and new treatment techniques. Each of these will influence the direction that the RTPS purchase should take. RTPS features can also force changes in the treatment planning process, as differences in areas such as image registration, plan normalization, and optimization may require technique and quality assurance changes in order to effect an orderly and safe transition. Finally, an upgrade strategy should be included in the purchase decision, so that future improvements in the RTPS can be effectively integrated into the overall treatment planning and delivery process. Educational Objectives: 1. To describe the overall planning process for the purchase of a radiation therapy planning system. 2. To identify key steps in the purchase process for a radiation therapy planning system under the aegis of the medical physicist.

Patient assessment of surgeons' interpersonal skills

PurposeAims to assess the surgeons' communication skills with patients in the orthopaedic department of the authors' district general hospital.Design/methodology/approachA departmental prospective audit was conducted involving all consultants and middle grade surgeons. Then authors used a validated questionnaire (Doctors' Interpersonal Skills Questionnaire (DISQ)) completed by patients and analysed independently. Feedback was obtained through individual confidential reports and a study group meeting.FindingsA total of 402 patient evaluations were received and the average interpersonal skills index was 72 per cent ranging between 55 per cent and 87 per cent. The highest scores were given for respect shown, warmth of greeting and patients' confidence in the surgeon's abilities. The lowest scores were given for time given to patients to express their concerns.Research limitations/implicationsThe research has an incomplete audit circle. A second audit is required following appropriate training to alleviate the deficiencies reported in the first audit and prove the benefit.Practical implicationsThis audit highlighted important deficiencies in our interpersonal skills that could potentially be addressed by way of targeted training. This kind of assessment should become an essential part of the annual appraisal process of all hospital doctors.Originality/valueThis paper is the first to report the results of a departmental assessment process of hospital doctors using the DISQ.

ISBT Code 128 implementation at a regional blood center

Application specifications for ISBT 128 bar code symbology and the International Council for Commonality in Blood Bank Automation (ICCBBA) were created in 1994. By June 2000, the FDA considered ISBT 128 a standard for uniform labeling of blood and blood components. Our blood center initiated a change process for ISBT 128 implementation and "went live" in 2003. The intention to adopt ISBT 128 symbology with hospitals was actively communicated in October 2001. A Codabar-ISBT label cross-reference book was developed, FDA approval for the fullface label format in April 2002 was requested, and FDA approval was received in March 2003. In December 2002, donor identification labels and number sets were ordered, and an integration test plan was subsequently developed with departmental process flowcharts for each of the nine affected departments. Each step was tested, the labeling changes were approved in May 2003, training was completed in June 2003, and ISBT bar code symbology was implemented on July 1, 2003. A written survey was sent to hospital transfusion services in April 2004. Implementation went smoothly except for an unanticipated high rate of "no-reads" on some analyzers in the testing lab. The hospitals spent an average of 18 hours preparing for changes, 14 hours on validation, 4 hours on documentation and procedure development, and 8 hours on training. ISBT bar code symbology was successfully implemented. Hospital transfusion services made some adjustments and, overall, readily accepted the new bar code symbology.

Contribution of anesthesia to workflow operation

The changes in our health care system caused by the introduction of DRGs make it necessary for us to abandon departmental process structures in favour of total hospital orientated process structures. An interdisciplinary approach is crucial to enable the most effective use of personnel and material resources. Future orientated information technology and organisational structures will enable us to process our patients effectively and efficiently from pre-admission to discharge. Anaesthesia has to be integrated into a patient management system for in- and out-patients. The essential matters for consideration are anaesthesia consulting hours, the common establishment of process structures for preoperative care, operation room management and postoperative patient care. Routine controls and analysis of the required teamwork reveal improvement potential and enable us to use the necessary control elements effectively.

Access to care: What should we be measuring?

Some of the key measures on which emergency departments are judged concern access to care. In Australasia, the most common current measure of access is the percentage of patients who are seen within a specified time for each category of the national triage scale. Access measures regarding availability of in-patient beds is less uniform, but tends to be related to the number of patients who spend longer than a specified time in the emergency department. There are, however, measurables that are demonstrative of departmental process rather than being simple waiting time quantiles. These include mean and median elapsed times, together with standard deviations and coefficient of variation for each of the indicators. These measures better describe the central tendency and spread of performance, both of which are fundamentally important to any measure of the quality of process. This paper discusses the use of these broader and more descriptive indicators of process.

The departmental budgeting process.

The departmental budgeting process.

The study of academic department performance

The paper proposes a systems model of academic department performance and reports an empirical test of the model in a set of 20 departments. Departmental input and process variables related to eight departmental outcomes were identified: (1) student satisfaction with their overall learning experience, (2) student satisfaction with faculty, (3) student satisfaction with academic advising, (4) student graduate school admissions ratio, (5) student employment in field ratio, (6) faculty satisfaction with departmental research quality, (7) faculty job satisfaction, and (8) degrees conferred per faculty member. The eight departmental outcomes were found to be largely independent of one another and predicted by relatively unique patterns of departmental characteristics. Salient among the correlates of departmental outcomes were faculty workload, tenure pattern, and disciplinary differences.